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1. Sense of coherence of reindeer herders and other Samis in comparison to other Swedish citizens

Abrahamsson, Agneta

et al.

Jönköping University, School of Health and Welfare. University College of Kristianstad,Kristianstad.

Lindmark, Ulrika

Jönköping University, School of Health and Welfare, HHJ. Oral health. Jönköping University, School of Health and Welfare, HHJ. ADULT. Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.

Background. Samis are indigenous people in north Europe. In the territory called Sa´pmi (Lapland), reindeer herding is the traditional base for the Sami economy. The relation between living conditions and positive health of the Swedish Samis has been sparsely studied. As health is closely linked to sense of coherence (SOC), an understanding of the background factors to SOC may contribute knowledge that might be useful in promoting living conditions and health.

Methods. The study examines relations between the level of SOC and background factors from surveys in a Sami population (n=613) in comparison to a non-Sami population (n=525) in Sweden, and in comparison between 2 subsamples of Samis, that is, herders and non-herders.

Results. There are more similarities than differences between the Sami and non-Sami populations. However, dividing the Sami population, reindeer herders had significantly lower SOC, and in specific the subcomponent manageability, that is, less ability to use available resources to meet different demands in life, compared to non-herders.

Conclusions. In addition to age and health, predictors of SOC are related to the life form of reindeer husbandry and the belonging to the herding community

Background: Children with intellectual disabilities living in developing countries are vulnerable to participation restrictions. Few studies have been made regarding their own perspectives. Aim: To describe how children in a low income country aged 13-17 with an intellectual disability perceive their participation in everyday life activities. Method: This bachelor thesis was conducted as a descriptive study and had a quantitative approach. Participants were collected through a non-probability, goal-oriented consecutive sampling. Data were collected by using “Picture my Participation”, an instrument designed as a structured interview with quantitative questions. The data were analyzed with IBM SPSS Statistics 21. Tables and diagrams were made in Microsoft Excel 2013. Result: The activity that the children participated in most frequently was “Daily routines at home for personal care (dressing, choosing clothing, hair care, brushing teeth)”. The activity that most children prioritized as most important, and they were most involved in was “Organised leisure activities”. “Services and policies” and “Social environment” were the factors seen as “Facilitators” to participation, whereas “Family attitudes” was seen as a “Barrier” to participation. Conclusion: The children perceived their participation in the prioritized activities as high and experienced few barriers in the context of participation.

The aim of this study was to describe experiences of pain and its relationship to daily activities in people with rheumatoid arthritis (RA). Method. Seven semi-structured focus group discussions were conducted with 33 men and women of different ages with RA. Data were analysed with content analysis. Results. Pain affected everyday life and may be a barrier to perform valued activities. Regarding the impact of pain on participation and independence, personal factors and the social environment were found to be important. It could be a struggle to find the right activity balance, since it was easy to be overactive, triggering subsequent elevation of pain levels. However, the participants also described activities as a mediator of pain and a distraction from it.Conclusion. The relationship between pain and daily activities in RA was complex. Pain as an impairment was expressed to be related to activity limitations and participation restrictions, as well as to contextual factors. These findings highlight the clinical importance of paying attention to the complexity of pain and its relation to daily activities and participation.

This study aimed to examine the difficulties with performing valued life activities in relation to pain intensity in women and men with rheumatoid arthritis (RA). In total, 737 persons with RA (73 % women) from three rheumatology units in Sweden responded to a questionnaire measuring performance of 33 valued life activities and self-rated pain. The relationships between performance of valued life activities (VLAs) and pain (measured by visual analogue scale (VAS)) were analysed based on gender. Multiple linear regression analyses were conducted with the total VLA score as dependent variable. Women reported more pain and difficulties in performing valued life activities than men. Across genders, 85 % reported at least one valued life activity affected by RA. Significantly more women than men encountered difficulties in performing some activities such as cooking, gardening and meeting new people. Women reported higher pain intensity (35 mm) than men (31 mm). Almost all 33 difficulty ratings for valued life activities were higher among persons with high pain (>40 mm) than persons with lower pain. Difficulty ratings for valued life activities correlated positively with pain in persons with lower pain, but not among those with high pain. The results highlight the importance of addressing pain, especially among women with RA, as they reported pain to impact on their valued life activities. Interestingly, this was evident also in women with lower levels of pain.

OBJECTIVES: To study differences regarding pain and activity limitations during the 3 years following diagnosis in women and men with contemporary treated early RA compared with their counterparts who were diagnosed 10 years earlier.

METHOD: This study was based on patients recruited to the Early Intervention in RA (TIRA) project. In the first cohort (TIRA-1) 320 patients were included in time for diagnosis during 1996-1998 and 463 patients were included in the second cohort (TIRA-2) during 2006-2009. Disease activity, pain intensity (Visual Analogue Scale, VAS), bodily pain (BP) in the 36-item Short Form Health Survey (SF-36), activity limitations (Health Assessment Questionnaire, HAQ), and medication were reported at inclusion and at follow-up after 1, 2, and 3 years.

RESULTS: Disease activity, pain, and activity limitations were pronounced at inclusion across both genders and in both cohorts, with some improvement observed during the first year after diagnosis. Disease activity did not differ between cohorts at inclusion but was significantly lower at the follow-ups in the TIRA-2 cohort, in which the patients were prescribed traditional disease-modifying anti-rheumatic drugs (DMARDs) and biological agents more frequently. In TIRA-2, patients reported significantly lower pain and activity limitations at all follow-ups, with men reporting lower pain than women. Women reported significantly higher activity limitations at all time points in TIRA-2.

CONCLUSIONS: Pain and activity limitations were still pronounced in the contemporary treated early RA cohort compared with their counterparts diagnosed 10 years earlier and both of these factors need to be addressed in clinical settings.

Background: Over the last decades the RA-treatment strategies have changed considerably. Routines for early RA diagnosis and instituted disease modifying anti rheumatic drugs (DMARDs) have been established. In the early 2000s biologic agents also became available for treatment purposes. Despite these altered and improved strategies RA patients continue to report pain and activity limitations; women more so than men.

Objectives: To study differences regarding pain and activity limitations during the first three years after diagnosis of RA in today's patients compared with patients diagnosed 10 years earlier from a gender perspective.

Methods: This study was based on patients recruited to the project “early interventions in RA” (TIRA). In the first cohort (TIRA-1) 320 patients were included during 1996-1998. In the second cohort (TIRA-2) 463 patients were included during 2006-2008. Disease activity score 28 joint count (DAS-28) and medication were registered. Pain intensity (VAS), bodily pain (BP) in Short Form36 (SF-36) and activity limitation (Health Assessment Questionnaire, HAQ) were reported at inclusion and at follow-ups after one, two and three years.

Results: Disease activity did not differ between cohorts at inclusion, but was significant lower at the follow ups in the TIRA-2 cohort compared with the TIRA-1 cohort. Patients in TIRA2 were prescribed traditional DMARD:s and biologic agents more frequent than in TIRA-1. The TIRA-2 patients reported significantly higher pain intensity and activity limitations at inclusion but lower pain intensity and activity limitations at all follow-ups than TIRA-1 patients. There were no significant differences between cohorts regarding bodily pain at inclusion, but thereafter the TIRA-2 patients showed significant lower bodily pain than the TIRA-1 patients. Men reported lower activity limitation than women in TIRA-1; otherwise there were no gender differences in TIRA-1. In TIRA-2, there were no significant gender differences regarding pain at inclusion. However, men reported lower pain than women at all follow-ups. Women, in turn, reported significantly higher activity limitations at all time points in TIRA-2. Pain and activity limitations were significantly reduced from inclusion to the one year follow-up but remained stable thereafter.

Conclusions: Both women and men in today's early RA patient cohort report lower pain and less activity limitations at the follow ups after diagnosis of RA compared to 10 years earlier. However, both activity limitations and bodily pain are still pronounced.

OBJECTIVE: To study whether personal factors (self-efficacy and pain acceptance) mediate the relationship between pain and performance of valued life activities in persons with rheumatoid arthritis.

METHODS: Persons with rheumatoid arthritis for at least four years (n = 737; 73% women) answered a questionnaire measuring self-efficacy, pain acceptance, performance of valued life activities, and self-rated pain. Relationships among these constructs were explored using univariate and multivariate analyses. Structural equation modelling was then used to examine the mediational role of personal factors on the relationship between pain and performance of valued life activities.

RESULTS: A direct negative association between pain and performance of valued life activities was identified (Beta = .34, P < .001). This suggests that people with rheumatoid arthritis who had higher levels of pain has increased difficulties in performing valued life activities. Self-efficacy and activity engagement component of pain acceptance mediated the relationship between pain and performance of valued life activities, however the pain willingness component of pain acceptance did not influence participation in valued life activities.

CONCLUSION: These findings highlight the importance of considering personal factors, such as pain acceptance and self-efficacy, in facilitating participation in valued life activities.

Background Experience of balance in everyday activities where work is an essential part is important to health and well-being, as has also been observed in previous studies in people with rheumatoid arthritis (RA). The Valued life activity scale (VLA-swe) is a questionnaire in which patient’s first report if the separate activities are valued or not to perform and secondly difficulties to perform these activities. Occupational Balance Questionnaire (OBQ) focuses on satisfaction with the amount and variation of occupations.

Objectives The objectives were to 1) describe the relationship between performance of valued activities and experienced occupational balance, and to 2) identify aspects associated with low occupational balance in persons with RA.

Methods 368 persons (age 18–65 years, 77% women) with RA responded to a questionnaire measuring occupational balance (OBQ) and performance of valued life activities (VLA-swe). Other aspects of interest were activity limitations measured by Health Assessment Questionnaire (HAQ), pain (measured by VAS), continuous stress (stressed continuously for more than a month during the last 12 months), children at home, education, and living situation. The relation between OBQ and performance in VLA across genders and Workers/Non-workers were analysed using non-parametric correlation analyses. To identify the impact of different aspects on the likelihood that participants would report lower occupational balance, OBQ was analysed using workers/nonworkers, stress, gender, age, pain and difficulties performing valued activities as independent variables in logistic regressions models. The study was approved by the Regional Ethics Committee (Dnr2011/452–31).

Results The OBQ was significantly related to difficulties to perform valued activities reported by VLA (r=-0.41, p<0.001). Having more difficulties performing valued activities was the strongest predictor of lower occupation balance and increased the risk of reporting lower occupation balance with nearly five times (OR=4.54, p 0.001). Continuous stress increased the risk of having lower occupation balance more than three times (OR=3.27, p<0.0001) than those who not reported being stressed. The other variables show no significant impact on the likelihood that the participants would report lower occupational balance.

Conclusions The results showed support for the relationship between occupation balance and performance of valued life activities and highlights to identify what’s important for the individual and to assume that in the rehabilitation. The results also show the importance of ability to manage stress, in order to enable for retaining ability to work and achieve high occupational balance.

SummaryTitle: Occupational therapists as a coach or paramedicOccupational therapists have a holistic view and works with each individual in focus, based on individuals abilities in relation to activity. The occupational therapy profession with its broad expertise and broad perspective of understanding is facing new challenges. The purpose of this study was to describe occupational therapists perception of working as a coach or as a paramedic. A qualitative method with a purposive sampling combined with a net-work sam-pling were used. Two focus group discussions were conducted. The number of participants were nine female working occupational therapists from a various scope of practice. The data-analysis was conducted through individual and group analysis and different categories were defined in accordance with the purpose. The occupational therapists combine the two roles as coach and paramedic in their work with different individuals. What employer and work area the occupational therapists work in, is essential for what approach they have. Economics, po-litical factors and the focus of the work influences. Depending on work area and focus, the individual has varying responsibility in their rehabilitation/treatment. The occupational thera-py education generates a joint terminology and an activity perspective that forms a common basis. The traditional professional roles has been revised, the question is whether coach is a buzz-word and paramedic more traditional? It’s essential that the profession has a clear profile and today occupational therapists apply for the same posts as other professions. In conclusion the occupational therapy profession is multifaceted with a common ground. Work area and the individual are essential for the occupational therapists approach in the rehabilita-tion/treatment.

22. Experiences of facilitators or barriers in driving education from learner and novice drivers with ADHD or ASD and their driving instructors

Almberg, Maria

et al.

Mobility Centre Gothenburg, Sweden.

Selander, Helena

Mobility Centre Gothenburg, Sweden.

Falkmer, Marita

Jönköping University, School of Education and Communication, HLK, CHILD. School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, Australia.

Vaz, Sharmila

School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, Australia.

Ciccarelli, Marina

School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, Australia.

Falkmer, Torbjörn

Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD. School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, Australia.

Objective: To explore the facilitators or barriers to driving education experienced by individuals with ASD or ADHD who obtained a learner’s permit, from the perspective of the learner drivers and their driving instructors.

Methods: Data were collected from 33 participants with ASD or ADHD, and nine of their driving instructors.

Results: Participants with ASD required twice as many driving lessons and more on-road tests than those with ADHD. Participants with ADHD repeated the written tests more than those with ASD. Driving license theory was more challenging for individuals with ADHD, whilst individuals with ASD found translating theory into practice and adjusting to “unfamiliar” driving situations to be the greatest challenges.

Children diagnosed with intellectual disability, ADHD och autism may experience that they have a reduced participation in their social network and the community. These diagnoses have symptoms that may have negative impact on the performance in the daily activities. According to studies, one of the symptoms that has an impact on the occupational performance for these children is the sensory processing of the stimuli in the child’s environment. The purpose of this bachelor thesis was to describe how a multisensory room can be used as an intervention for children with intellectual disabilities, ADHD and/or autism to increase participation. The bachelor thesis was a Scoping Review where 20 articles and chapters from a book was included. Inclusion criteria for the articles was studies about children to the age of 18 years, diagnosed with ADHD and/-or autism, use of a multisensory room and sensory processing in children with ADHD and autism. The articles could be a quantitative-, qualitative-, or systematic review studies. The reference lists of the systematic reviews studies were reviewed to exclude that an article wasn't already reviewed. The articles would be written in Swedish or English, published between 2005 and May 2018, would be available in full text and peer reviewed, The results describes how a multisensory room can be used as an intervention for the population of the bachelor thesis, the effects and how the multisensory room offers different stimuli that can satisfy the child’s sensory needs. This can contribute to a positive effect by increasing the occupational performance and participation. The conclusion is that occupational therapists can use multisensory rooms as an intervention and it can be offered to children with ADHD and autism and it shows a positive effect on their participation in their occupational performance.

During 2017, 1,189 people died due to suicide in Sweden. Suicide is a complex problem and a multifaceted approach is required to prevent suicide. The aim with this study was to describe occupational therapists’ perceptions and experiences regarding suicide prevention and how occupational therapists’ competence can be used in work regarding suicide prevention. A qualitative study including three focus groups and an individual interview with a total of eight occupational therapists were conducted. Data was therefore analysed using qualitative content analysis. Two categories were revealed in the result: Suicide prevention in practice and Treatment and knowledge about suicidal patients. The participants have not earlier reflected on their role in suicide prevention and experience a fear and insecurity in the meeting with suicidal patients. The concepts meaningfulness and participation are emphasized as important. The therapeutic alliance is the basis for the patient to want, or dare, to talk about suicidal thoughts and/or suicidal behaviours. The participants also emphasize the importance of taking the patient's focus and having an inside perspective. The conclusions are that occupational therapists need training regarding suicide prevention to further clarify their roles, and to feel safe in the meeting with suicidal patients. Occupational therapists, with their competence, can deepen and broaden the understanding of suicidal actions and promote the individual’s mental health in the long term to prevent suicide.

Aim: The purpose of the thesis was to describe older adults (65 and older) perceptions about changes to their occupational patterns and wellbeing after a move to a special care facility. Method: A qualitative interview with semi-structured questions and estimated wellbeing on a VAS-scale was performed on ten older adults living in special care facilities. The sampling was a convenient sampling with a secondary purposive sampling. The sampling of participants was made from two separate special care facilities, one in a city and one in a town. A qualitative data analysis was performed to analyses the collected data. Results: The result showed that the participants perceived changes to both occupational patterns and wellbeing after a move to a special care facility. The participants perceived that they had more recreational activities or leisure activities and less household chores or mustdo-activities after moving to a special care facility. Many meaningful physical activities had become hard to perform and had been replaced with less demanding activities. Conclusion: Occupational patterns and estimated wellbeing was affected by the move to a special care facility. The aspects of aging were perceived to affect the change as well.

High school youths experience a lot of stress, mainly because of studies. The mental illness among young people increases and girls are significantly more stressed than boys. Stress can affect the study motivation negatively and can lead to interruptions that delay entry into the labor market. The aim of the study was to survey occupational balance and stress among girls and boys at vocational programs in high school. A quantitative study in the form of a survey was conducted with 50 respondents at various upper secondary schools in southern Sweden. Spearman's rank correlation coefficient (rho)was used to analyze whether there was any relationship between occupational balance and stress. The majority of respondents had medium occupational balance (39) or higher, there was no statistically significant difference in occupational balance between the sexes. There was a statistically significant difference in perceived stress between the sexes, girls perceived more stress than boys. There was a statistically significant relationship between occupational balance and perceived stress in girls. To enable for young people to maintain or improve occupational balance can be a way to promote and prevent stress and other mental illness.

Interventions for elderly people with a focus on existential health - A scoping review.Background: The elderly population will increase, which means an increased need for care and support to ensure that good health can be maintained. The concept of health includes physical, mental and social well-being. It is becoming increasingly common to also consider an existential dimension in terms of health. Interventions aimed at existential health have shown a positive result. The duty of occupational therapists is to work client-centered and strengthen each patient's emotional and physical well-being based on each individual's unique conditions. Spirituality is part of every human being and is therefore an important part of occupational therapists to consider. Purpose: To map and describe interventions for elderly people with a focus on existential health. Method: A literature study in the form of a scoping review has been used. Articles have been collected through searches in the databases AMED, CINAHL and PubMed. Eleven articles have finally been used in the work and the result has been reviewed and analyzed numerically and thematically. Results: The interventions have been mapped and described in the following categories: place for the interventions, spiritual interventions, interventions aimed at meaning and purpose of life, communication-based interventions aimed at existential health and the care providers' education and execution of interventions aimed at existential health. Conclusion: Individually designed interventions aimed at the existential health of elderly people give a positive result in the form of better physical and mental health. The feeling of having a purpose and a meaning with life is important and gives the individual an increased well-being. Further research needs to be done.

Purpose To identify and establish the number and aetiology behind children being killed or injured during school transport from a door-to-door perspective by using experience from Sweden and the UK. Methods Available crash data were analysed. Results In total, 361 children in Sweden during 1994–2001,i.e. 24% of the 1,515 identified children aged 6 - 16 who were injured or killed were identified in 256 school transport events. The predominant reason for being killed or injured when travelling on school transportation was when children were outside the bus (74%), either when passing the bus to cross the street, running in front of the bus (21%) or behind the bus (30%). Contrary to the general belief that children older than 12 are mature enough to handle traffic, more than 50% of the fatal injuries in Sweden affected children aged 13 –16. Similar results were found in the UK. The afternoon school journeys, pedestrians after alighting from the bus, and those in situations that deviated from their normal routine were found to be particularly vulnerable. Conclusions The travel chain perspective/or door to door perspective offers a promising approach for understanding school transport risks and for identifying effective countermeasures; including around bus stops and on the way to/from the bus stop. Data collection needs to be revised to reflect this approach.

Road crash statistics reveal that school children are frequent victims and the most risky situation is when the child is outside the bus. The aim of this pilot study was to explore possible changes in speed, implementation of routines, hazard detection and child security gains from a driver support system integrated with intelligent bus stops and additional technical equipment.

Methods

In total, 130 children with transmitters were using two specially equipped busses and bus stops. Speed of oncoming and overtaking cars, implementation of routines, the possibilities to discover potential hazards and experienced stress in the children were analysed by speed measurements, diary notes, questionnaires and focus group interviews.

Results

This pilot study exploration showed that the speeds of other road users were reduced at one of two bus stops. The driver support system was frequently used in all its parts and was considered useful by the bus drivers. It also raised the level of routines and allowed the drivers to survey the children. Children reported feeling more secure with the system running and experienced less stress as a consequence of it.

Conclusion

This pilot study shows that the evaluated systems may have the ability to reduce speed of other road users, raise the level of routines and make children feel more secure. Further studies are needed that apply a holistic approach on school transportation safety and security.

Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).

Fristedt, Sofi

Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).

Background: Sexual health is an important issue in daily life, but little is known about occupational therapy (OT) students’ views on these matters.

Aim: To explore occupational therapy students’ views on addressing sexual health in their future professional role.

Material and methods: A descriptive qualitative study involving 37 OT students in 5 focus groups was performed and analyzed using content analysis.

Results: Three categories: ‘Sexual health is part of occupational therapy and but not of the OT educational program’; ‘Need for knowledge to identify and intervene related to sexual health problems’; and finally, ‘Communication about sexual health—unknown, untried, but necessary’, formed the theme, ‘Willing to try, wanting to know more, and recognizing not only the difficulties and challenges but also the importance of sexual health in OT practice’.

Conclusions: OT-students consider sexual health as part of OT-practice, but experience lack of knowledge of sexual health related to disease/disability, cultural diversity, and age and sexual orientation. Educational programs need to cover these matters, including how to address sexual health in OT-practice, to enhance OT’s future competence related to promotion of sexual health for clients.

Significance: Knowledge on students’ views are vital to guide education on this important, rather neglected, area.

Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).

Thidell, Fredrik

Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation.

Rolander, Bo

Jönköping University, School of Health and Welfare, HHJ, Dep. of Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue).

Ramstrand, Nerrolyn

Jönköping University, School of Health and Welfare, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health and Welfare, HHJ. CHILD.

Prosthetists and orthotists have a responsibility to direct treatment toward enabling their clients to perform desired activities and to facilitate participation of their clients in all areas of life. This may include provision of assistive technologies to help clients meet goals related to participation in sexual activities. To help prosthetic and orthotic students develop competencies in dealing with the sexual health of their future clients, it is necessary to generate knowledge of their own perceived competence and capacity.

Objectives:

To explore prosthetic and orthotic students’ attitudes and competence toward working with sexual health and to evaluate reliability and validity of the Students’ Attitudes Towards Addressing Sexual Health questionnaire.

Study design:

Cross-sectional study.

Methods:

Students enrolled in all three years of an undergraduate prosthetic and orthotic program were requested to complete the Students’ Attitudes Towards Addressing Sexual Health questionnaire (n = 65). Reliability and validity were evaluated using the content validity index and Cronbach’s alpha.

Results:

Students felt unprepared to talk about sexual health with future clients and thought that they would be embarrassed if they raised the issue. No differences were identified between students enrolled in each of the three years of the program and few differences were observed between male and female students. The content validity index values were low but improved as the students’ level of education increased. Internal consistency of the questionnaire was acceptable (α = 0.86).

Conclusion:

Prosthetic and orthotic students are unprepared to address sexual health issues with their future clients. There is a need to provide students with training related to sexual health issues.

Clinical relevance:

This study indicates the need for additional education of prosthetic and orthotic students in issues related to sexual health and how to address sexual health issues with clients. Results can be used to develop training programs for students and will serve to improve the sexual health of individuals who receive prosthetic and orthotic services.

Background. Knowledge about how people with severe mental illness find meaning in non-work occupations is important in order to develop programmes of meaningful daily occupations for this group.

Purpose. To examine the meaning daily occupations may bring to those who are severely mentally ill and unemployed.

Methods. Twelve unemployed people with severe mental illness were interviewed regarding their experience of meaning in daily occupations.

Findings. Meaning was experienced in a balance between occupations that helped the informants control their mental illness. Themes of meaning were: feeling competent and being socially engaged, having routines and being productive, being creative and seeking knowledge, and taking care of body and mind. Substitutes for paid work were found in occupations such as taking care of the household or being productive at a day centre.

Implications. People with severe mental illness should be allowed to play an active role in their rehabilitation process, using the occupational therapist for forming daily routines, creating a balance between work-like and restful occupations, finding occupations that meet one’s skills and training social behaviour. Besides, work-related occupations should be emphasized in the rehabilitation.

Background, mental health has declined among children in Sweden and many of them does not meet the recommendation for physical activity. The importance of leisure activities is relatively well researched from the perspective of children, however, the parent’s view is less studied. The purpose of the study was to describe parent’s perception of the importance of children’s participation in organized leisure activities. The method used was quantitative design with semi structured interviews. Purposive sampling was used, where 11 participants participated. The material was processed using qualitative content analysis. The result gave a varied perception of the importance of participation in leisure activities for children. It was about the importance of community, development and lessons from the leisure activities. The self-confidence children received during leisure activities, the importance of confirmation and the physical value also had significance. The need of limitations also emerged. Conclusion, the variation but also the similarities in the result have given an in-depth picture of the subject. The common description was that the leisure activity provided joy, development, well-being and a context. The hope is that the study will lead to a greater extent of the use of leisure activities as a health-promoting tool for occupational therapists.

Jönköping University, School of Health Science, HHJ, Dep. of Rehabilitation. Jönköping University, School of Health Science, HHJ. Quality improvements, innovations and leadership in health care and social work.

The Code of Ethics for Occupational Therapists stipulates how occupational therapists should think about the profession’s central concepts in practice, where ‘Health’ is one such concept. Other guiding principles for practice are the Occupational Therapy Process Model and the ARTUR Case Record Structure. The aim of this study has been to identify and describe how occupational therapists at a hospital in Sweden documented interventions in patient case records. A stratified and random sample of one hundred case records was evaluated in relation to a checklist. The results showed that only 21 percent of the case records were complete. Often, the notes were found under the wrong keyword and 12 percent of the occupational therapy cases were indistinct and did not belong to any of the intervention categories in which occupational therapists normally intervene. Despite this, the majority of the case records reflected the ICF’s Activity/Participation component, which could be interpreted to mean that the occupational therapists held holistic health notions in line with the code of ethics. In order to improve the occupational therapists’ documentation in patient case records, further discussions of the central concepts and guiding principles for occupational therapy are required.

To assess whether variables from a postural control test relate to and predict falls efficacy in prosthesis users.

Design

Twelve-month within and between subjects repeated measures design. Participants performed the Limits of Stability (LOS) test protocol at study baseline and at 6-month follow-up. Participants also completed the Falls Efficacy Scale-International (FES-I) questionnaire, reflecting the fear of falling, and reported the number of falls monthly between study baseline and 6-month follow-up, and additionally at 9- and 12-month follow-ups.

Setting

University biomechanics laboratories.

Participants

A group of active unilateral transtibial prosthesis users of primarily traumatic etiology (PROS) (n=12) with at least one year of prosthetic experience and age and gender matched control participants (CON) (n=12).

Interventions

Not applicable.

Main Outcome Measure(s)

Postural control variables derived from centre of pressure data obtained during the LOS test, which was performed on and reported by the Neurocom Pro Balance Master, namely; reaction time (RT), movement velocity (MVL), endpoint (EPE) and maximum (MXE) excursion and directional control (DCL). Number of falls and total FES-I scores.

Results

During the study period, the PROS group had higher FES-I scores (U = 33.5, p =0.02), but experienced a similar number of falls, compared to the CON group. Increased FES-I score were associated with decreased EPE (R=-0.73, p=0.02), MXE (R=-0.83, p<0.01) and MVL (R=-0.7, p=0.03) in the PROS group, and DCL (R=-0.82, p<0.01) in the CON group, all in the backwards direction.

Conclusions

Study baseline measures of postural control, in the backwards direction only, are related to and potentially predictive of subsequent 6-month FES-I scores in relatively mobile and experienced prosthesis users.